2.6 applying the biopsychosocial perspective

Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated.
This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.

教学方

Charmaine Williams

Associate Professor

脚本

So, you should of already watched the TED talk, A Tale of Mental Illness from the Inside by Elyn Saks. If you haven't watched that talk, you need to go back and watch it because you're going to be quite lost. So Elyn Saks is an Associate Dean and Professor of Law at the University of Southern California Gould Law School. She's an expert in mental health law and has done a lot of writing about the intersection between psychiatry and the law. And you probably won't be surprised that she's written a book about the use of restraints. She, as she says has a diagnosis of schizophrenia and she wrote about this experience in an autobiography that was published in 2000, 2007 called "The Center Cannot Hold: My Journey Through Madness". I think her TED talk is really good. I hope you notice that it touches on a lot of issues we've already discussed like stigma against mental illness, media portrayals of mental illness, and the association between inadequately treated mental illness. And the incarceration of people who have mental health diagnoses. So let's start by looking at what Professor Sachs has told her, us about. what in her life promotes her mental health. We're looking at this, of course, through a bio-psychosocial perspective. So, in the area of mental health she mentions that psycho-pharmacology has been part of her excellent treatment and one of the reasons she has been able to keep well. So, I've located this in biological since psycho-pharmacological drugs. Work biologically. in fact, she knows that she accepted psycho-pharmacological treatment after years of what she called denying the truth. Wanting to believe that the less medication she took the less detec, the less defective she was. So this decision to take biological treatments isn't just really biological. It kind of actually even moves over into the psychological as well. Because it represents her capacity and her willingness to shift her beliefs in order to promote better health for herself. So these are both things that are Clearly promoting her mental health. Also, in the area of psychology, she speaks of having excellent psychotherapy in stimulating and meaningful work. If you're thinking about the research that's been done in, in neuroplasticity. These definitely sound like the kind of things that promote positive changes in the brain. But even just staying in the psychological realm. They promote positivity and engagement with the world. And are the basis for positive relationships. For example, she says that her workplace embraces her needs. These types of positive relationships. Relationships are important to sustaining a positive image of the self, and therefore. Promote good mental health. I've also included her practice of writing down her experiences and checking them out with other people. Even when she was in the midst of a psychosis episode. I see this as an indication of positive coping behaviors. In these periods of stress she's able to reach out to others. And she's able to check in with herself. She also has the courage to maintain a record of what's happened to her. So that she has a realistic assessment of the situation. I'm hoping that you remember having a realistic assessment of one's abilities and limitations is one of the things that has been suggested to be part of positive mental health, wellness, and well-being. Now in the familial domain, it's very clear that Professor Saks feels very supported by her husband, friends, and family. She knows that they know her and her illness. This type of close, functional social support is a positive addition to her mental health picture. In the social realm, I've been more explicit about this social report, social support, including the social support available in her workplace, but also noted that Professor Saks is obviously someone with significant social capital. Her social capital is indicated by her access to supportive social networks. This is what was called a social safety network in a social determinance of health discussion. And the social position and respect that's associated with being a dean and a professor of law is also another source of social capital. Even having the time and the resources to be able to attend four to five days of psychoanalytic treatment a week is suggestive of significant social capital. Maybe even financial capital. That's not something that everyone can access. Finally, in the environmental realm we can probably make some assumptions about the stability of her environment based on her social capital. And also the fact that she happens to be located in southern California in the United States. Event taking into account earthquakes, it's a fairly, it's a fairly stable environment. One thing that is definitely clear that as part of her social environment she clearly has access to help, something that we have already noted as a important social determinant of health. So you can see there are lots of things in Professor Sack's life that promote her mental health. And even from this brief introduction to her life we can see she has strong positive resources across all bio, psycho, social domains. She of course also deals with things that threaten her mental health. Most apparent. Is that biologically, she has a history of serious and persistent mental illness. She identifies her diagnosis as paranoid schizophrenia. It's clear that the illness has been serious. And she discloses that she has experienced hundreds of days in hospitals. And tells us about episodes of psycho psychosis. And I think it's fair to describe it as a persistent mental illness because she has clearly had multiple episodes. And still talks in the present tense about when I am psychotic, and how occasionally I have hallucinations. Professor Saks makes no pretense that her illness is something that's just in her past. She is realistic or honest about it's ongoing presence in her life. Psychologically I was not aware of any issues threatening her mental health. In the past there was what she described as denying the truth. But that clearly isn't an issue anymore. I actually want to spend a moment talking about this issue of denial. Because it's one that comes a little up a ot when we're talking about mental illness. I found in the work that I do, this is something that I've done research on. That what we often describe as denial can be conceptualized as if it represents some kind of maladaptive ego defense. Or some kind of psychological shortcoming that's getting in the way of people gaining what we call insight into illness. I don't think that's a fair characteriz, characterization. I think we could just as easily think of this as a process of testing out different possibilities and explanations for what is happening. Before finding one that feels right for the person. That being said. The consequences associated with not accepting treatment for illnesses like schizophrenia can be very high. And certainly it seems those consequences were high for professor Saks in the past. Moving on to the familial realm. We have no knowledge of anything in the familial realm that represents risks to her mental health. In the social realm we do see that she has dealt with the fear of consequences from disclosing her experience of mental illness. Her story about the discussion with another law professor who told her that people with mental illnesses aren't troubled by being restrained because they aren't like the rest of us. That story made me feel sick. Its very troubling to, to realize that there are people that think of diagnosis of mental illness somehow strips people off their humanity. That they are no longer than rest of us. Unfortunately such attitudes exist and always have. As we seen. Those kinds of attitudes and the stigma that I've named in the environmental realm create an environment of fear, tension and stress. Think of the oppression related stress that I described earlier. These undoubtedly have an effect on people's mental health. Professor Saks has obviously taken on a task of disclosing her mental illness as part of a larger project of ad, of addressing attitudes and laws that have a negative effect on people who are diagnosed with mental illnesses. But of course she does that in an environment where it is attached to risk. One of the reasons I wanted to do this course was because I feel it's incredibly important that we commit ourselves to creating environments in which the social risks are decreased. I think that the more people we equip to be able to do that anti stigma work, the better this world will be for everyone's mental health. So as we look at the bio-cycle social picture for Professor Elyn Saks, we can see that there are definitely both things that promote her mental health, and potentially pose risk to her mental health. Hopefully what you also see, is that it's possible the reason that she's able to have such a successful and effective life, despite the risk to her mental health, is that she has so many other factors that promote her mental health. They provide the type of balance and resources that enable her to deal successfully and effectively with the things that are risk to her mental health. So I'm paraphrasing Professor Saks here when I say persons with mental illness can lead full, happy, and productive lives if they have the right resources. So is professor Elyn Saks mentally healthy or mentally ill? Well, I have to admit it's a bit of a trick question. You might have noticed that in the grid that I gave you with the bio-psychosocial perspective, I didn't actually even have mentally ill there. I just talked about whether. We were promoting mental health or looking at risks to mental health. So, I have to tell you that my bias is that I don't like to talk about whether people are mentally ill in that sense. I think that people have experiences of mental illness. They experience periods of mental illness. But the reason I resist. Deciding whether somebody is mentally ill in that way is because I worry sometimes that when we use that term it becomes like this master status that erases everything else about them. So once you're put into this box called. Mentally ill, then. A lot of other things don't seem to be in that box any more. We lose side of the fact that people are also mothers and there teachers and they have, hoobies and they have interests and they have all kinds of other things going on in their lives, because we have assigned, this particular label. So that's why I tend to talk about people's mental health and whether people experience episodes of mental illness. So, with that in mind I think it's very clear that professor Saks actually has a lot going on in her life that promotes her mental health, and when you look at the two. Sides together in terms of what's undermining your mental health and what's promoting your mental health. It's pretty clear that there are a lot of things that are promoting her mental health, that probably make it possible for her to deal with the things that are risk to her mental health. I think the lesson that we can all learn from that is even if we think biologically. We have this potential. For mental health problems, for mental illness, even psychologically and socially. There are things that we can put in place and there are things that we as a society can put in place, that can promote mental health, and make it much easier to deal with those things effectively and successfully. I think that's a lesson we really see quite clearly from Professor Sacks life. And I think it's a lesson that we can all sort of take for ourselves. So with that I'm going to ask you to think about what is the balance of bio psycho social. At the bio-psycho-social factors in your life. What kind of things do you have in place that promote mental health? What kind of things do you have in place that maybe present risks to your mental health? And is there anything that you can be doing, or are doing, that helps to shift your balance that you're experiencing mental health as much as you can? I'll leave you with that thought, and we'll finish up next.